Health surveillance of Glasgow medical undergraduates pursuing elective studies abroad (1992-1998)

Patterns of diseases in health students abroad: A systematic review

BACKGROUND

Different health risks are associated with international electives among medical students, including the transmission of infectious diseases and non-communicable diseases. This review aims to summarise the evidence for illnesses associated with travel in medical students taking part in electives abroad.

METHODS

Articles were identified through a literature search in two databases (until 30 July 2020) - PubMed and Web of Science.

RESULTS

Sixteen articles were included in the systematic review. The results were classified into two broad categories: communicable diseases and non-communicable diseases. Gastrointestinal infections including travellers' diarrhoea were the most common infectious diseases reported by medical students abroad, followed by respiratory tract infections and skin infections. Blood-borne and sexually transmitted infection and systemic febrile infections due to vector-borne pathogens were rarely reported. Only six of the 16 studies addressed microbial carriage. The acquisition of resistant bacteria appeared to be frequent. Traffic accidents and mental health problems were also reported.

CONCLUSIONS

One of the lessons learned from this review is the requirement for large-scale epidemiological studies to evaluate the burden of infectious diseases such as gastrointestinal, respiratory and blood-borne infections with microbiological documentation. In particular, the emergence of the acquisition of resistant bacteria may lead to a theoretical risk of spread to the community and hospitals. Studies addressing mental health issues in the context of medical electives abroad are also needed.

Protecting the health of medical students on international electives in low-resource settings

BACKGROUND

Increasingly, medical students from developed countries are undertaking international medical electives in developing countries. Medical students understand the many benefits of these electives, such as the opportunity to develop clinical skills, to gain insight into global health issues and to travel to interesting regions of the world. However, they may be much less aware of the risk to their health and wellbeing while abroad. Compounding this problem, medical students may not seek advice from travel medicine practitioners and often receive inadequate or no information from their medical school prior to departure.

METHODS

The PubMed database was searched for relevant literature relating to the health of medical elective students. Combinations of the following key words were used as search terms: 'international health elective', 'medical student' and 'health risks'. Articles were restricted to those published in English from 1997 through June 2017. A secondary review of the reference lists of these articles was performed. The grey literature was also searched for relevant material.

RESULTS

This narrative literature review outlines the risks of clinical electives in resource-poor settings which include exposure to infectious illness, trauma, sexual health problems, excessive sun exposure, mental health issues and crime. Medical students may mitigate these health risks by being informed and well prepared for high-risk situations. The authors provide evidence-based travel advice which aims to improve pre-travel preparation and maximize student traveller safety. A safer and more enjoyable elective may be achieved if students follow road safety advice, take personal safety measures, demonstrate cultural awareness, attend to their psychological wellbeing and avoid risk-taking behaviours.

CONCLUSION

This article may benefit global health educators, international elective coordinators and travel medicine practitioners. For students, a comprehensive elective checklist, an inventory of health kit items and useful web-based educational resources are provided to help prepare for electives abroad.

Ensuring the Health, Safety and Preparedness of U.S. Medical Students Participating in Global Health Electives Overseas

Global health electives based in resource-poor countries have become extremely popular with medical students from resource rich ones. As the number of such programs and participants increase, so too do the absolute health and safety risks. It is clear from a number of published reports that many institutions provide little or no meaningful preparedness for students and do little to ensure their health and safety. These deficiencies together can affect students, their foreign hosts, and sponsoring institutions. The School of Public Health at the State University of New York, Downstate Medical Center, and its predecessor, the Department of Preventive Medicine and Community Health, have sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purposes of this elective are to provide students with an opportunity to observe the health care and public health systems in resource-poor countries, provide medical service, and have a cross-cultural experience. Over the course of the past 35 years, 386 students have participated in this global health elective in more than 41 resource-poor countries. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews, has resulted in the selection of highly mature, adaptable, and dedicated students who have performed well at overseas sites. Appropriately preparing students for an overseas global health experience in resource-poor countries requires the investment of much professional and staff time and effort. At the SUNY Downstate School of Public Health, these resources have underpinned our Global Health in Developing Countries elective for many years. As a result, the elective is characterized by meticulous organization, extensive preparedness measures for students, and continuous monitoring of site and country safety. The health of students is ensured by one-on-one assessment of immunization needs, anti-malarials, and the provision of a five-day supply of post-exposure HIV prophylaxis. Students sign agreements regarding the legal issues, immunizations, and anti-malarials recommended as well as HIV post-exposure prophylaxis. They are also required to obtain medical evacuation insurance provided by the university, and medical care insurance valid overseas. Student travel plans are also approved as is in-country lodging. The focus of our 6-8 week global health elective is not clinical medicine. Rather, it is to enable students to learn about the health care and public health systems in a resource-poor country. Through that focus, they also come to understand the causes of health and health care disparities that exist in the country to which they are assigned. Our students are greatly advantaged with regard to cross-cultural understanding since our school is located in New York City's Borough of Brooklyn, where 40 % of the population was born outside of the U.S. Our comprehensive effort at risk management for this global health elective includes a thorough debriefing for each student upon his/her return. Special attention is given to ascertaining illness or injury while overseas, and, when necessary, immediate referral is made to an appropriate university clinical department where a student can be appropriately case managed. Meticulous oversight, careful selection of safe overseas sites, and attention to preparing students have resulted in significant risk reduction and successful experiences for the majority of our 386 students. This article describes the model we have developed for ensuring the health, safety, and preparedness of students participating in our global health elective.

Illness and risk behaviour in health care students studying abroad

CONTEXT

The numbers of university students studying abroad increase every year. These students are not tourists as their studies require different types of travel that expose them to different risks. Moreover, health care students (HCSs) may be exposed to even greater risks according to their travel destinations and itineraries. Clearly, research-based pre-travel advice is needed.

METHODS

This study reports on a prospective survey conducted from April 2010 to January 2014 of health care and non-health care students from Swedish universities in Umeå, Stockholm and Gothenburg studying abroad.

RESULTS

Of the 393 students included in the study, 85% responded. Over half (55%) were HCSs. Pre-travel health information was received by 79% and information on personal safety by 49% of HCSs. The rate of illness during travel was 52%. Health care students more often travelled to developing regions and were at increased risk for travellers' diarrhoea. One in 10 experienced theft and 3% were involved in traffic accidents. One in five met a new sexual partner during travel and 65% of these practised safe sex. Half of all participants increased their alcohol consumption while abroad; high alcohol consumption was associated with increased risk for being a victim of theft, as well as for meeting a new sexual partner during travel.

CONCLUSIONS

University authorities are responsible for the safety and well-being of students studying abroad. This study supplies organisers and students with epidemiological data that will help improve pre-travel preparation and increase student awareness of the potential risks associated with studying abroad.

Electives in undergraduate medical education: AMEE Guide No. 88

This Guide outlines the scope and potential roles an elective can contribute to undergraduate medical training and identifies ways to maximize learning opportunities, including within global health. The types of educational activity available for electives range from meeting individual educational need through to exploration of potential career pathways, with many factors influencing choice. Key areas of organization underpinning a successful elective before, during and after the placement include developing clarity of the intended educational outcomes as well as addressing practicalities such as travel and accommodation. Risk management including the implications for the participating schools as well as the student and their elective supervisors is crucial. This Guide would not be complete without some discussion around ethics and professional conduct during an elective, with consideration of the impact of elective placements, particularly in low-middle income countries.

Student nurse perceptions of risk in relation to international placements: a phenomenological research study

BACKGROUND

International nursing electives have been identified as a positive learning experience for students. However, whilst there are risks associated with international student placements in general, there is a scarcity of research specifically relating to student nurse's experiences of risk.

OBJECTIVE

This study aimed to investigate UK undergraduate student nurse experiences of risk during an international placement.

DESIGN AND METHODS

A phenomenological methodology was applied and semi-structured interviews were conducted with student nurses who had recently returned from an international clinical placement abroad.

SETTING AND PARTICIPANTS

Ten, second year student nurses, studying on a pre-registration diploma/BSc (Hons) Nursing Studies/Registered Nurse programme from one UK University participated in the study.

FINDINGS AND CONCLUSIONS

Findings from the study highlighted that students felt that three types of risk existed; physical risk, clinical-professional risk and socio-cultural risk. Perceptions of risk were influenced by sociological theory relating to the concept of 'the other' and students attempted to reduce risk by employing strategies to reduce 'Otherness'. They also applied psychological theory relating to heuristics such as 'safety in numbers.' It also emerged from the study that exposure to perceived risk enhanced learning as students reported that it encouraged personal and professional development in particular and so assisted students in their move toward self-actualisation. It is suggested, and intended, that findings from this study can be applied to the preparation of students to further enhance their safety and learning experience during international placements abroad.

Health risks encountered by Dutch medical students during an elective in the tropics and the quality and comprehensiveness of pre-and post-travel care

BACKGROUND

Clinical and research electives abroad offer medical students many unique experiences. However, participating in an unfamiliar health-care setting combined with limited medical experience may place students at risk of illness. To improve pre-and post-travel care, we assessed the health risks and the quality and comprehensiveness of pre-and post-travel care in a cohort of Dutch medical students returning form an elective abroad.

METHODS

All medical students who had performed an elective in the tropics between July 2006 and December 2008 were sent an informative email asking them to complete a web-based questionnaire.

RESULTS

180 of 242 (74%) students completed the questionnaire. Regarding the risk of bloodborne viral infection: 67% of all students and 32% of junior students engaged in procedures that constitute a risk of exposure to bloodborne viral infection, often in countries with high HIV prevalence rates. None of nine students who experienced possible or certain mucosal or percutaneous exposure to potentially infectious body fluids reported the exposure at the time it occurred and none used PEP. Regarding other health risks: 8 of 40 (20%) students stopped using mefloquine due to adverse effects. This left a sizeable proportion unprotected in countries that are hyperendemic for malaria. Post-travel screening for schistosomiasis, tuberculosis (tuberculin skin test) and carriage of methicillin-resistant Staphylococcus aureus (MRSA) encompassed approximately half of all students who should have been screened.

CONCLUSIONS

Based on the results of this study we have adopted an integral set of measures to reduce the health risks associated with an elective abroad. The pre and post-travel consult has been centralized and standardized as well as the distribution of PEP. In addition we have developed a mandatory module on Global Health for all medical students planning an elective abroad.

Attitude and practice of medical students studying in Hungary and India toward health during overseas and domestic travel

BACKGROUND

It is presumed that medical students are travelers who can take care of their health, and thus the present study was conducted to elicit the attitude and practice [AP] of medical students from two different countries toward travel health issues.

OBJECTIVES

To elicit the attitude and practice of medical students from two different countries toward travel health issues and identify the reasons for any variations.

MATERIAL AND METHODS

An anonymous pre-tested structured questionnaire consisting of socio-demographic details, travel aspects, travel health issues, and precautions [medicines carried, vaccination history, and pre-travel consultation] adopted was distributed to 250 foreign medical students studying at the University of Debrecen, Hungary [Group I] and another 250 native medical students in India [Group II]. Data were analyzed by simple descriptive statistics and Student t-test.

RESULTS

A total of 428 students responded among total eligible population of 500; 228 [90.2%] in group I and 200 [80%] in group II. In 2008, 188 [82%] of the former and 33 [16.5%] of the latter groups traveled to international destinations. Among groups I and II, health problems were experienced by 73 [32%] and 65 [32.5%] students, respectively. During hospitalization, students of group I were admitted for one of the following illnesses such as severe asthma, dehydration, malaria, and tibial fracture, while two other students were admitted to the hospital with deep vein thrombosis [DVT]. During travel, the category of medicines carried by students belonging to group I/II were anti-diarrhoeal [75/19], anti-emetics [53/39], anti-giddiness [49/7], anti-histamines [55/12], anti-pyretics plus analgesics [197/70], anti-spasmodics [55/11], antibiotics [33/10], vitamin pills [84/0], and laxatives [47/6]; supportive items such as adhesive plaster [64/3], and thermometer [37/1]; personal protective materials viz., mineral water [165/88], hygienic food [100/132], insect repellents [86/14], special clothes such as full sleeves and cap [150/0], sun screen [160/14], and items against sexually transmitted diseases [159/0]; health documents such as medical insurance card [161/3], previous health records [40/0], immuno-prophylaxis [127/0], family physician's phone number [43/9] and pre-travel advice [57/2].

COMMENTS

Students studying in Hungary were better informed about travel-related issues than native students from Indian medical colleges. The probable reasons for such variations were cultural differences, variation in their pre-medical curricula and teaching, frequent travel, a previous university degree, military training, maturity, and staying away from parents. The overall attitude and practice of medical students toward travel health issues were sub-optimal, since the subjects taught did not focus much on travel and health-related issues. Hence, there is an urgent need to initiate standardized teaching in the field of travel medicine for the students of health sciences for the benefit of the community.

International Health Electives: Four years of experience

More than 2 million people each day move across international borders as a consequence of increases in international travel, trade and immigration. Medical electives are an important and expected part of the medical curriculum in many medical schools and many students travel abroad to do their electives. This part of the course has not been subjected to the rigorous analysis of learning processes and expected outcomes that have been matters of course for other components of the medical curriculum. This paper explores issues around the elective period in the UK describing the current status of medical electives in medical schools and presenting the experience of an innovative programme in which a 4-week module on International Health was linked with the elective period. The paper describes how it is possible to incorporate into the medical curriculum a preparatory module for students planning to take an overseas elective, with potential positive outcomes.

The adolescent traveler

Oh, to travel again with the carefree attitude of the adolescent! Yet most readers will think that this enormous list of precautions would merit never letting the adolescent out of the house. The traveler and his or her provider can be reassured that with appropriate (and confidential) forethought, the journeys that lie ahead can be joyful and healthy. The bottom line? The more information obtained before travel both for the traveler and his or her family, the less morbidity will be incurred. The primary care provider is in the perfect position to provide all of these services to the adolescent traveler.